Bioceramic versus conventional endodontic sealers: An umbrella review

Sealers are important to provide hermetic obturation of root canals. Traditional sealers have wide clinical applications but are limited by cytotoxicity, solubility, and biocompatibility. However, bioceramic sealers offer bioactivity, alkaline antibacterial properties, and dentin bonding are the properties of bioceramic sealers, which still have concerns of extrusion, retreatment, and fewer long-term studies are available.

The objective of the study was to compare the clinical characteristics of bioceramic and conventional root canal sealers in permanent teeth.

The umbrella review was registered in PROSPERO and followed the guidelines of the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. Seven databases (PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Central, Cochrane Database of Systematic Reviews, LILACS) as well as grey literature sources were searched comprehensively and in English. This last update of the search was made on May 10, 2026. Systematic reviews and meta-analyses that included randomized or clinical trials study designs were eligible. Data extraction and methodological appraisal (AMSTAR-2) was performed in duplicate.

A total of 17 systematic reviews (2021-2026) were included. In terms of postoperative pain, analgesic consumption, postoperative flare-up, radiographic healing, extrusion, retreatment difficulty, and long-term success, there was no difference between bioceramic and resin-based sealers. Minimal effect on pain at 24-48 h and somewhat beneficial healing were reported for bioceramic sealers, but the differences were small. There were no high-quality reviews identified, and 76% of the methodological appraisal of reviews was rated as being of a critically low quality, which reduced confidence in the conclusions.

Bioceramic sealers demonstrate biological advantages but remain broadly equivalent to conventional resin-based sealers in clinical effectiveness. Observed short-term benefits are modest and not clinically decisive, while extrusion variability and retreatment difficulty highlight practical limitations.